Respiratory protection market in North America will reach USD 2.64 billion by 2025

US Revenue Cycle Management Market was valued at USD 26.24 billion in 2019 and is estimated to reach USD 29.13 billion by the year 2020.

It is expected to grow at the CAGR of 11% within the time horizon of 2020-2025 because of supportive governmental regulations and growing health care expenditure.

It will reach USD 49.08 billion by the year 2025.

Definition / Scope
Market Overview
Market Risks
Top Market Opportunities
Market Trends
Industry Challenges
Technology Trends
Pricing Trends
Regulatory Trends
Market Size and Forecast
Market Outlook
Technology Roadmap
Distribution Chain Analysis
Competitive Factors
Key Market Players
Strategic Conclusion
References
Appendix

Definition / Scope

Revenue cycle management is the automatic system in which the healthcare facilities use medical billing software to manage the administrative and clinical aspects of processing claims, payments, and generating revenue of the health care services.

This system tracks the revenue of the patient care from registration to the final payment of the health care services through the electronic health record system.

It facilitates the health services providers to understand the cash flow and revenue goals as well as to enhance the efficiency of the health care delivery system and reduce billing errors. Based on the type of product, the US revenue cycle management market is segmented into the software and services.

As the end-users of the revenue cycle management is concerned, it consists of physician back office, hospitals, diagnostic laboratories, and others.

Market Overview

Globally, the market size of the revenue cycle management market is valued at USD 64.3 billion in 2019. The market value of the global revenue cycle management market is expected to grow at the CAGR of 12.1% within the forecasted period of 2020-2025.

The total market size of the US revenue cycle management market is valued at USD 26.24 billion in 2019 and is expected to reach USD 29.13 billion by the year 2020.

Its market value is expected to grow at the CAGR of 11% within the forecasted period of 2020-205. Its market value will reach USD 49.08 billion by the end of the year 2025.

Based on the type of product, the software segment is leading the market with a market share of 66.66% of the total US revenue cycle management market. The market size of this segment is valued at USD 17.49 billion in 2019.

Based on the end-users, the physician back office segment is dominating the market with a market share of almost 41.66% of the total US revenue cycle management market. The market value of this segment is valued at USD 10.93 billion in 2019.

Supportive governmental policies and growing healthcare expenditure are the factors driving the growth and development of the US revenue cycle management market. However, delays in receiving payments and increasing medical billing errors might restrain the growth and development of the US revenue cycle management market.

The key market players engaged in the operation of its market are Allscripts, Athenahealth, Epic Systems, McKesson, and Cerner.

Market Risks

Delay in receiving payments

A well-designed efficient revenue cycle management is often a time-consuming process in which payment claims shuffled between the health care service providers and the payers for a series of the month.

In the survey conducted by Instamed in 2016, almost 70% of the health care service providers have reported that the revenue cycle management system takes about a month to receive the payment of the medical services from the patients.

This delay in the process of the payment receipt might create the risk for the growth and development of the revenue cycle management market in the United States.

Top Market Opportunities

Growth in healthcare expenditure

In the context of the United States, healthcare spending is in increasing trend. The healthcare expenditure grew by almost 4% and has reached USD 3.6 trillion in 2019. It is expected to reach USD 4.3 trillion by the end of the year 2023 and USD 6 trillion by the year 2027.

Along with this, the per capita spending on health care services has also been increased by almost 3.2%. This growing expenditure in the sector of health care is favoring the growth and development of the revenue cycle management market in the United States.

Rising use of cloud computing solutions

The United States has one of the largest markets for cloud computing and is one of the topmost countries in terms of spending on cloud computing technologies. Almost USD 124.6 billion was spent by the United States in 2019.

The market size of the US cloud computing market is valued at USD 120.17 billion in 2019. As the end-users of cloud computing are considered, the health care segment accounts for almost 6.25% of the total US cloud computing market, and the market size of the health care cloud-based computing market is valued at USD 7.51 billion in 2019.

This growing application of cloud computing is creating a significant opportunity for the growth and development of the US revenue cycle management market.

Market Trends

Supportive government reforms

The government of the United States is developing the reform programs in favor of the adoption of the revenue cycle management system.

For instance, the Affordable Care Act of the United States has focused on the expansion of health insurance coverage and the reduction of healthcare costs, which promote the use of the revenue cycle management systems.

Along with this, the government of the United States has promoted the use of the HER system through the development of the Health Information Technology for Economic and Clinical Health Act and Medicare HER incentive programs. These governmental reforms are driving the growth and development of revenue cycle management.

Increasing inclination of patients towards outpatient visits

Within almost two decades, the proportion of outpatient services as a part of all hospital revenue has been increased from 28% to 47%. Along with this, the number of outpatient centers has also been increased by 51% within a time horizon of a decade.

The total number of outpatient visits in hospitals in the United States has increased to 880.5 million visits. This increasing inclination of the patients towards outpatient visits is increasing the revenue of the hospitals.

Thus, the increasing shifting of the patient towards outpatient services is driving the growth and development of the revenue cycle management market in the United States.

Increasing medical billing errors

It has been estimated that almost 80% of all medical bills contain billing errors, which will increase the chances of the rejection of the medical claim from the insurance company.

The most common cause of the billing errors is the incorrect diagnostic coding on the bill. It is usually common in the medical bills totaling more than USD 10,000. Along with this, the complaints from the patients also in an increased trend.

According to Kaiser Health News, in almost 350 complaints obtained from the 32 states, most of the patients were assaulted by the heavy medical bills. It might restrain the growth and development of the revenue cycle management market.

Industry Challenges

Staying up-dated with medical billing regulations

The rules and regulations related to the billing of the medical services are constantly changing. Along with this, the international coding regulations of the health disorders also keep changing in every ten years.

Because of this, the medical staffs including physicians and other administrative staffs should engage and update themselves about the changes through education and training.

So, it is quite challenging for the market players engaged in the revenue cycle management to remain updated with the changing medical billing regulations.

Technology Trends

Advancement in technology and innovative technological solutions are favoring the environment for the use of revenue cycle management. Some of the key technological changes occurring in this market are discussed as follows:

Cloud-based solutions: This technological solution store a large amount of health-related data making the revenue cycle management process more cost-effective and efficient in health care settings. It allows the medical administrative committee to access the required data at any time and location.

Natural language processing: This technological solution uses the technique of linguistics, computer science, and artificial intelligence to process natural language data. It assists the revenue cycle management to analyze the patient information.

Machine learning: It is a part of the artificial intelligence in which machine develops its algorithm for advanced tasks. It focuses on making a prediction based on mathematical modeling using computers.

Robotic process automation: This technology is based on software robots and digital workers, which produces the actions to automate the concerned tasks through the application of the graphical user interface.

Pricing Trends

The price of the revenue cycle management system depends upon the type of technology, application, and type of product. The price of the revenue cycle management software differs from the types of software.

Some of these software offers a 30 day free trial and are needed to upgrade for the premium features. For instance, the PracticeSuite software offers the 30-day free trial and the subscription price of this software is USD 195 per month for solo practice, USD 1,950 for mid-sized, and USD 4,875 per month for a large practice.

The price of the DrChrono is about USD 499 for solo practice, USD 4,990 for mid-sized, and USD 12,475 for large practice per month.

The price of the CollaborateMD ranges from USD 165 to USD 345 per month for solo practice, USD 1,650 to USD 3,450 per month for mid-sized and USD 4,125 to USD 8,625 per month for a large practice.

Regulatory Trends

In the context of the United States, the Healthcare Business Management Association regulates the revenue cycle management industry for both commercial insurance and governmental agencies.

Along with this, it provides the training and education services for the healthcare professionals engaged in the management of the revenue cycle. Some of the key regulations directly or indirectly related to the revenue cycle management market in the United States are discussed as follows:

Health Information Technology for Economic and Clinical Health Act: This act has developed incentivesrelated to healthcare information technology. It promotes the use of the electronic health record system for the health care services providers.

Medicare Access and CHIP Reauthorization Act: It was developed in 2015 which promotes value-based care and value-based reimbursement in the healthcare delivery system.

Affordable Care Act: This act was developed in 2010 by the United States Congress, which consists of the health care delivery system reforms to improve quality and decrease healthcare costs.

Market Size and Forecast

The total market size of the global revenue cycle management market is valued at USD 64.3 billion in 2019 and is expected to grow at the CAGR of 12.1% within the forecasted period of 2020-2025.

The total market size of the US revenue cycle management market is valued at USD 26.24 billion in 2019 and is expected to reach USD 29.13 billion by the year 2020.

Its market value is expected to grow at the CAGR of 11% within the forecasted period of 2020-205. Its market value will reach USD 49.08 billion by the end of the year 2025.

Based on the type of product

The software segment is leading the market with a market share of 66.66% of the total US revenue cycle management market. The market size of this segment is valued at USD 17.49 billion in 2019.
The services segment accounts for 33.33% of the market share of the total US revenue cycle management. The market size of this segment is valued at USD 8.74 billion in 2019.

Based on the end-users

The physician back office segment is dominating the market with a market share of almost 41.66% of the total US revenue cycle management market. The market value of this segment is valued at USD 10.93 billion in 2019.
The hospital segment accounts for almost a market share of 22.22% of the total US revenue cycle management. Its market size is valued at USD 5.83 billion in 2019.
The diagnostic laboratories segment accounts for almost a market share of 12.22% of the total US revenue cycle management. Its market size is valued at USD 3.20 billion in 2019.

Market Outlook

The US revenue cycle management market is expected to grow at the CAGR of 11% within the forecasted period of 2020-2025 because of supportive government policies and growing healthcare expenditure. Its market value will reach USD 49.08 by the year 2025.

Technology Roadmap

Adoption of technological solutions such as robotic automation, machine learning, voice assistants is creating a favorable environment for the growth and development of the revenue cycle management in the United States.

Along with this, cloud-based solutions store a large amount of health-related data and allows the medical administrative committee to access the required data at any time and location.

Natural language processing uses the technique of linguistics, computer science, and artificial intelligence to process natural language data. These technological changes are driving the growth and development of the revenue cycle management market in the United States.

Distribution Chain Analysis

The key stakeholders engaged in the operation of the revenue cycle management market are patients, healthcare providers, billing companies, and insurance players.

The revenue management cycle consists of the charge capture, claim submission, coding, patient collections, registration, remittance processing, third-party follow-up, and utilization review.

At first, the health facilitates render the health care services into billable charges, and claims of the billable fees are submitted to insurance companies. The medical procedures and diagnoses are coded properly following ICD-10 codes.

Once the patient schedules the appointment with the physician, the hospital staff collects adequate information of the patient from registration to the final treatment procedure. The payment of the services delivered to the patient is collected from either third-party insurers or the patient itself.

Competitive Factors

The key market players engaged in this US revenue cycle management market are focused on the development of the new solutions for cloud-based space. Along with this, they are competing for the management of the medical billing errors in the revenue cycle management system and its software.

They are also focused on the development of training and education programs for the health care billing professionals to minimize the errors.

Key Market Players

Short profile of the key market players engaged in the US revenue cycle management market are discussed as follows:

Allscripts: This organization develops and sells software and services for a variety of health care service providers.

Athenahealth: It is engaged in the development of the cloud-based electronic health recording system for small and medium-size health care institutions and physicians clinics.

Epic Systems: it is one of the largest developers of health information technology to access, organize, store, and share patient medical records. It is widely used by the health institutions of the United States.

McKesson: It is one of the United States-based companies engaged in the development of medicines, pharmaceutical supplies, and health care IT products and delivery of the services.

Cerner: This company provides a variety of health information technologies with its specialization in the development of electronic health record systems and medical devices.

Strategic Conclusion

The United States Revenue Cycle Management Market is growing at a rate of 11% because of supportive government policies and growing healthcare expenditure in the United States.

However, delay in receiving payments and increasing trend of medical billing errors might restrain the growth of its market. So, the market players must be focused on the development of advanced technological solutions to address medical billing errors.

References

Appendix

ICD= International classification of disease
US= United States
HER= Health Electronic Record
USD= United States Dollar
CAGR= Compound Annual Growth Rate